Inside Health

PERSONAL HEALTH; After Smoking and Fats, Focus Turns to Salt

By JANE E. BRODY

Published: January 26, 2010

In decades past, when companies wanted to test-market a product meant to enhance health and well-being, they often tried it first in California -- where people were reputed to be the most health-conscious in the country. But now companies might be wise to consider field-testing their wares in New York City.

If he can take credit for nothing else, the city's mayor, Michael R. Bloomberg, can rightfully claim to have launched a national effort to help people live more healthfully. He began with a prominent campaign to curtail smoking, the single leading killer of Americans, by banning it in restaurants and bars, and followed that with a campaign to get heart-damaging trans fats out of packaged and restaurant foods.

Next Mr. Bloomberg attacked rampant obesity (though New York, being a walking city, is leaner than most other metropolitan areas) by promoting a requirement that chain restaurants prominently display the calorie content of all their offerings.

And at his urging, the city health department is seeking to curtail consumption of sugary soft drinks, with subway advertisements that ask riders, ''Are you pouring on the pounds?''

Now Mr. Bloomberg has called on restaurant chains and food producers to lower the amount of salt in their products by 25 percent over the next five years. The goal is to reduce the incidence of high blood pressure, a major contributor to heart attacks, strokes and kidney disease.

If the mayor has his way, this could well be the year when salt, once a form of legal tender, is finally devalued as a prized condiment in the American diet. As happened with trans fats and calorie listings, other cities and states may follow New York's example, if for no other reason than to control rapidly rising public health costs.

Saving Money and Lives

In a scientific analysis published last week in The New England Journal of Medicine, researchers at the University of California, San Francisco; Stanford University; and Columbia University College of Physicians and Surgeons calculated that if Americans reduced their salt intake by half a teaspoon a day, or three grams (the equivalent of 1,200 milligrams of sodium, the health culprit in salt), the nation would save up to $24 billion a year in health care costs.

The research team, led by Dr. Kirsten Bibbins-Domingo, an epidemiologist and biostatistician at U.C.S.F., concluded that even a much more modest reduction -- one gram a day, achieved gradually by the year 2019 -- ''would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.''

And money is not the only thing that would be saved. The researchers calculated that the half-teaspoon reduction would ''reduce the annual number of new cases of coronary heart disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction [heart attack] by 54,000 to 99,000, and reduce the annual number of deaths from any cause by 44,000 to 92,000.''

That, dear reader, would be a very big bang for a relatively small buck. The researchers' suggested salt reduction would hardly render food tasteless, especially if the reduction is done gradually, as Mr. Bloomberg has proposed. Currently, the average American man consumes 10.4 grams of salt a day, and the average American woman consumes 7.3 grams.

''This is a classic example of a lifestyle change that has a modest effect on individuals but a huge effect on the population over all,'' Dr. Lee Goldman, a cardiologist at Columbia's medical school and co-author of the new study, said in an interview.

''With our current high-salt diet, all our blood pressures are increased, and the risk of heart disease with each rise in blood pressure is continuous.''

About 80 percent of the salt in the American diet comes from processed and restaurant-prepared foods, the main targets of Mr. Bloomberg's proposal. But for some people, including the mayor, meaningful cutbacks in how much salt they consume will also require restraint at the table.

The mayor is reported to add salt to almost everything, even saltine crackers, already-salted popcorn and bagels. If so, he is probably well above the amounts of sodium recommended by federal health authorities: 2,300 milligrams a day for otherwise healthy individuals; 1,500 milligrams for the elderly, those who already have high blood pressure and African-Americans, who are especially prone to developing high blood pressure.

A Federal Classification

Salt has escaped federal regulatory action because it is classified as GRAS, or ''generally recognized as safe.'' The Center for Science in the Public Interest, a health advocacy group based in Washington, has been urging the Food and Drug Administration for three decades to change this classification and instead regulate salt as a food additive that requires proof of safety for the amounts used.

Failing that, in 2005, the center petitioned the agency to set maximum levels of salt in various categories of food. A public hearing was held in 2007, but no regulatory action has been taken.

Meanwhile, millions of Americans continue to get sick and die of ailments caused or complicated by salt in the foods they eat.

The average daily intake of sodium exceeds 4,000 milligrams -- nearly double what a healthy person should consume. The explosive growth of fast foods has not helped matters. Last year, the Washington center published the sodium content of a number of popular restaurant meals that each provided 4,000 or more milligrams of sodium.

For example, at Olive Garden, a meal of chicken parmigiana, one breadstick, salad with house dressing and raspberry lemonade totaled 5,735 milligrams of sodium, the equivalent of two and a half teaspoons of salt.

At Chili's, a meal of Buffalo chicken fajitas with tortillas, condiments and a Dr Pepper totaled 6,916 milligrams of sodium, or three teaspoons of salt. Even the rather innocent-sounding Dairy Queen meal of a spicy chili bowl, a side salad with fat-free ranch dressing and a Mountain Dew added up to 4,500 milligrams of sodium.

City health officials acknowledged that it would be hard to legislate a reduction in salt, as finally happened with trans fats when a call for voluntary elimination fell on deaf ears.

But several companies have already expressed support. The supermarket chain A.& P. plans to follow the city's recommendation to reduce salt in the hundreds of store-brand products it sells. And the fast-food chain Subway announced its commitment to the guidelines at its nearly 23,000 stores nationwide.

Consumers, meanwhile, would be wise to check the sodium content per serving on food labels and select lower-sodium brands. When eating out, consider asking that salt not be added to the foods you order. You can always sprinkle on a little at the table. If you cut back gradually, your taste buds will adapt painlessly.